COVID-19 resources

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Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

Lancet

Background: COVID-19 has affected care home residents internationally, but detailed information on outbreaks is scarce. This research aimed to describe the evolution of outbreaks of COVID-19 in all care homes in one large health region in Scotland. Methods: This study did a population analysis of testing, cases, and deaths in care homes in the National Health Service (NHS) Lothian health region of the UK. This study obtained data for COVID-19 testing (PCR testing of nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and deaths (COVID-19-related and non-COVID-19-related), and this study analysed data by several variables including type of care home, number of beds, and locality. Outcome measures were timing of outbreaks, number of confirmed cases of COVID-19 in care home residents, care home characteristics associated with the presence of an outbreak, and deaths of residents in both care homes and hospitals. This study calculated excess deaths (both COVID-19-related and non-COVID-19-related), which this study defined as the sum of deaths over and above the historical average in the same period over the past 5 years. Findings: Between March 10 and Aug 2, 2020, residents at 189 care homes (5843 beds) were tested for COVID-19 when symptomatic. A COVID-19 outbreak was confirmed at 69 (37%) care homes, of which 66 (96%) were care homes for older people. The size of care homes for older people was strongly associated with a COVID-19 outbreak (odds ratio per 20-bed increase 3·35, 95% CI 1·99–5·63). 907 confirmed cases of SARS-CoV-2 infection were recorded during the study period, and 432 COVID-19-related deaths. 229 (25%) COVID-19-related cases and 99 (24%) COVID-related deaths occurred in five (3%) of 189 care homes, and 441 (49%) cases and 207 (50%) deaths were in 13 (7%) care homes. 411 (95%) COVID-19-related deaths occurred in the 69 care homes with a confirmed COVID-19 outbreak, 19 (4%) deaths were in hospital, and two (<1%) were in one of the 120 care homes without a confirmed COVID-19 outbreak. At the 69 care homes with a confirmed COVID-19 outbreak, 74 excess non-COVID-19-related deaths were reported, whereas ten non-COVID-19-related excess deaths were observed in the 120 care homes without a confirmed COVID-19 outbreak. 32 fewer non-COVID-19-related deaths than expected were reported among care home residents in hospital. Interpretation: The effect of COVID-19 on care homes has been substantial but concentrated in care homes with known outbreaks. A key implication from the findings is that, if community incidence of COVID-19 increases again, many care home residents will be susceptible. Shielding care home residents from potential sources of SARS-CoV-2 infection, and ensuring rapid action to minimise outbreak size if infection is introduced, will be important for any second wave.

Last updated on hub: 09 November 2020

Evolution and impact of COVID-19 outbreaks in care homes: population analysis in 189 care homes in one geographic region

medRxiv

This article is a preprint and has not been peer-reviewed. The lead researcher is Jennifer K Burton. Method: Analysis of testing, cases and deaths using linked care-home, testing and mortality data for 189 care-homes with 5843 beds in a large Scottish Health Board up to 15/06/20. Findings: 70 (37.0%) of care-homes experienced a COVID-19 outbreak.Interpretation: The large impact on excess deaths appears to be primarily a direct effect of COVID-19, with cases and deaths are concentrated in a minority of care homes. A key implication is that there is a large pool of susceptible residents if community COVID-19 incidence increases again. Shielding residents from potential sources of infection and rapid action into minimise outbreak size where infection is introduced will be critical in any wave 2.

Last updated on hub: 15 July 2020

Expanding frontiers of risk management: care safety in nursing home during COVID-19 pandemic

International Journal for Quality in Health Care

Background: Nursing homes provide long-term care and have residential-oriented hospitalizations characterized by medical, nursing, and social-care treatments for a typically geriatric population. In the current emergency phase, the problem of infections in residential structures for the elderly is taking on considerable importance in relation to the significant prevalence rates of COVID-19. Safety improvement strategies: Prevention and control measures for SARS-CoV-2 infection in nursing homes should be planned before a possible outbreak of COVID-19 occurs and should be intensified during any exacerbation of the same. Each facility should identify a properly trained contact person—also external—for the prevention and control of infections, who can refer to a multidisciplinary support committee and who is in close contact with the local health authorities. The contact person should collaborate with professionals in order to prepare a prevention and intervention plan that considers national provisions and scientific evidence, the requirements for reporting patients with symptoms compatible with COVID-19, the indications for the management of suspected, probable or confirmed cases of COVID-19. Discussion: Adequate risk management in residential structures implies the establishment of a coordination committee with dedicated staff, the implementation of a surveillance program for the rapid recognition of the outbreaks, the identification of suitable premises and equipment, the application of universal precautions, the adaptation of care plans to reduce the possibility of contagion among residents, the protection of operators and staff training initiatives.

Last updated on hub: 31 August 2020

Expanding possibilities: flexibility and solidarity with under‐resourced immigrant families during the COVID‐19 pandemic

Family Process

The novel coronavirus has added new anxieties and forms of grieving to the myriad practical and emotional burdens already present in the lives of underserved and uninsured immigrant families and communities. This article relates to experiences since the COVID‐19 crisis to the lessons that have be learned over time as mental health professionals working with families in no‐cost, student‐managed community comprehensive health clinics in academic‐community partnerships. This paper compares and contrast the learnings of flexibility of time, space, procedures, or attendance acquired in this clinical community setting during regular times, with the new challenges families and therapists face, and the adaptations needed to continue to work with our clients in culturally responsive and empowering ways during the COVID‐19 pandemic. This paper describes families, students, professionals, promotoras (community links), and IT support staff joining together in solidarity as the creative problem solvers of new possibilities when families do not have access to Wi‐Fi, smartphones, or computers, or suffer overcrowding and lack of privacy. This paper also describes many anxieties related to economic insecurity or fear of facing death alone, but also how to visualize expanding possibilities in styles of parenting or types of emotional support among family members as elements of hope that may endure beyond these unprecedented tragic times of loss and uncertainty.

Last updated on hub: 14 October 2020

Experiences of child and adolescent to parent violence in the Covid-19 pandemic

University of Oxford

This report draws upon the findings of online surveys of 104 parents who have experiences C/APV from their child aged 10-19 years and 47 practitioners who work with families experiencing C/APV. It also draws data provided by all 43 police forces across England and Wales on total numbers of reported C/APV incidents over the one-year period from 1st April 2019 to 31st May 2020. The analysis reveals that 70% of parents reported an increase in violent episodes during lockdown; 69% of practitioners said they had seen an increase in referrals for families experiencing C/APV; 64% of practitioners identified that the severity or incidence of violence had increased; 29% of parents identified a decline in C/APV during the lockdown period which was explained by a reduction in the stresses and triggers for violence in this period. Respondents identified some lockdown-specific reasons for the increase in C/APV, which include spatial confinement and coerced proximity, changes in structure and routine, fear and anxiety and lack of access to formal and informal support. The report makes ten recommendations to services, local authorities, and government in planning a response to C/APV, including ensuring robust safeguarding measures for young people and families experiencing C/APV; planning for a rise in demand for support as lockdown lifts and schools and workplaces reopen; avoiding over-criminalisation of young people using violence; and providing safe spaces for families at crisis point and respite care for young people.

Last updated on hub: 24 August 2020

Experiences of virtual children's hearings: a rapid consultation

Centre for Excellence for Looked After Children in Scotland

Findings of a rapid consultation to identify key areas of focus for further strengthening the experience of virtual children’s hearings in Scotland. Children’s hearings are the primary forum in which issues of juvenile justice, care, and protection relating to children and young people are handled. Due to restrictions as a result of the Covid-19 pandemic, virtual hearings have taken place using video-conferencing technology. The study indicates that many of those involved felt that moving to virtual hearings was a positive step forward and offered advantages and beneficial opportunities to participants. These included a more familiar environment for young people parents and carers, reducing the time and cost of travel whilst ensuring the hearings could still go ahead, and that innovative practice had been established in trying to ensure everyone was listened to and able to take part. However, the findings also identified some aspects of virtual hearings that participants found more challenging and which impacted on their participation. These included accessing paperwork, confidential space for advocates and participants, and technological barriers. Fairness, how inclusive a virtual hearing can be, and the rights of children, were key concerns also raised for further development. The report identifies key areas of focus for continuous improvement where the experience of virtual hearings can be strengthened, including ensuring children and young people have the opportunity to speak to the panel on their own if they or the panel wish; ensuring participants are fully supported; and are given access to the paper ahead of the hearing.

Last updated on hub: 11 August 2020

Explanatory memorandum to The Adoption and Children (Coronavirus) (Amendment) Regulations 2020

Department for Education

This explanatory memorandum from the Department for Education describes the temporary changes made by the Statutory Instrument Adoption and Children (Coronavirus) (Amendment) Regulations 2020. The instrument temporarily amends 10 sets of Regulations relating to children’s social care to support services manage the coronavirus (COVID-19) outbreak. The changes aim to support services to manage the increased pressure on children’s social care and staff and carer shortages who are ill with coronavirus.

Last updated on hub: 27 April 2020

Exploiting isolation: offenders and victims of online child sexual abuse during the COVID-19 pandemic

European Union Agency for Law Enforcement Cooperation

This report examines activities involving the sexual abuse and exploitation of children online and related offline crimes with a particular focus on how offenders have used their time during COVID-19 confinement to increase children’s vulnerability. The findings of this report are mainly based on contributions from Member States and Europol’s partner countries and input from a number of organisations. Key findings are: there have been significant increases in activity relating to child sexual abuse and exploitation on both the surface web and dark web during the COVID-19 lockdown period; travel restrictions and other measures during the pandemic have likely prevented offenders from travelling and so have shifted their focus to the exchange of child sexual abuse material (CSAM) online; an increase in the number of offenders exchanging CSAM online during lockdown may have an impact on and stimulate demand for this type of material online beyond the lockdown; increases in detection and reporting of CSAM on the surface web during lockdown indicate the level of re-victimisation of children through the distribution of images and videos depicting them; consistent levels of activity by offenders on the dark web during lockdown reflects the ongoing organised business model that has evolved and the level of threat that it poses to children; society, including law enforcement, needs to focus on the self-generation of CSAM to ensure that children are protected from this type of exposure to harm; the increased circulation of CSAM during the COVID-19 pandemic will also increase the need for law enforcement to identify the victims depicted in it; it is critical to continue to promote preventive and educational initiatives in a coordinated and structural manner across Europe.

Last updated on hub: 06 July 2020

Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK

Journal of Interprofessional Care

The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after.

Last updated on hub: 21 August 2020

Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK

Journal of Interprofessional Care

The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after.

Last updated on hub: 01 November 2020